Sunday, November 8, 2009

What on Earth is your reasoning to take hospital call when you don't want to take care of patients?

I can only assume it's money. Our local community is well aware of your lack of competency, and I don't know anyone who refers to you.

I'm the neurologist on call this weekend, and you ordered 10-15 consults for me, some of which made sense, and some of which were bullshit which defied even the normal boundaries of defensive medicine.

What REALLY chaps my hiney, though, is your uncaring stupidity. Let's review some of the conversations I had with nurses this weekend.

Dr. Grumpy: "This is Dr. Grumpy."

Nurse X: "Yeah, you saw Mrs. Jones this morning, the old lady who can't walk? Dr. Hummingbird told me to call you. She wants to discharge her home if it's okay with you."

Dr. Grumpy: "Is she any better?"

Nurse X: "No she still can't walk. But Dr. Hummingbird said she can lie in bed at home, too."

OR

Dr. Grumpy: "This is Dr. Grumpy."

Nurse Y: "Yeah, you saw Mr. Smith this morning, the man who came in with a TIA? Dr. Hummingbird told me to call you. She wants to discharge him home if it's okay with you."

Dr. Grumpy: "What did his tests show?"

Nurse Y: "He hasn't had any of them yet. Dr. Hummingbird said that since they may not get done until later today, that we should just send him home now because she's got a barbecue to go to this afternoon, and won't be here to write discharge orders."

OR

Dr. Grumpy: "This is Dr. Grumpy."

Nurse Z: "Yeah, you saw Mrs. Stevens this morning for her left hand pain? She's now having severe stomach pain, and had a stool with a lot of blood in it."

Dr. Grumpy: "Why are you calling me?"

Nurse Z: "Dr. Hummingbird told me to call you. She said that since the patient has a neurological issue with her hand that's she's uncomfortable managing any aspect of her care and that you should deal with whatever comes up".

I have nothing against these nurses. They know you for who you are, too, and are stuck because you ordered them to make these inane calls to me.

I'd like to blame this on your lack of experience, or just having a crappy weekend, but this happens every time I wind up on call with you, and my call partners say similarly flattering things about you. And you've been doing this crap for 8 years now.

Why doesn't Dr Hummingbird, call you himself? Afraid of the responses from you? One of the most uncaring docs around. His bbq more important than, the patients. I don't know how you do it Dr G. The idiots you deal with on a day to day basis.

As a nurse, if a Doctor, no matter how stupid they are, tells us to call another Doctor we still have to call. The patient has to be treated and if one Doctor shifts the responsibility, we have to keep passing it until we find someone who will assist the patient. We are the patient advocates. Now, what I do when a doc makes such a stupid demand is make the doc write the order for the call. I can refuse telephone orders and verbal orders, which means the doc has to get off their ass and come in and it documents what the doc is doing. Yes, a doc can give us hell, but as nurses, we are very capable o making a doc's life a living hell.

I've refused to follow stupid orders before. One of our covering hospitalists is terrible. Patient's BP was 80/40 and he told me to get him up to walk and see if his blood pressure is better post ambulation. Uhm, no.

So yeah, I have told doctors to stop ordering stupid stuff.

In the above cases, I would likely ask something to the effect of, "Do you REALLY want me to make that phone call and tell Dr. Grumpy that?" And if they did, would make the call. I'm sure Dr. Grumpy or whomever knew that it was Dr. Hummingbird's idea and use exact quotes.

Hmmmm...I used to work on med surg unit where every patient was being followed by multiple services.

It wasn't my job to coordinate all the following services for discharge, it was the admitting physicians'. The most I would do is let the admitting know that service x had rounded and wrote "ok for d/c" or "will sign off for now".

I would have instructed Dr. Hummingbird to call Dr. Grumpy herself. Nurses have enough to do with patient care and coordinating with Social work, home care, case mgmt etc to be relaying messages between physicians.

I'm not a nurse...but in extreme cases (like dumb consults, or orders that don't make sense in terms of therapy), I find it would be better to go over someone's head.

IE: Old lady with poor renal function that had two antibiotics for endocarditis ordered by her attending that go through...guess what! Renal excretion!! He's a nice/good doc and all, did his research...but we didn't want to potentially wreck the patient...so...

Solution: We got an ID doc to write orders. Went over the attending's head, but we did it to be SAFE.

Hannah-- some docs might take this BS out on the nurse but as a nurse you learn not to take anything too personal. I guess I would try to get Dr. Hummingbird to deal with the bleed (or at least consult GI), but there's not much else you could do. As far as the discharges, I think the nurses were probably just glad they could find a reason (Dr. Grumpy) to postpone them until the patients were actually treated.

It depends on the relationship you have with the doctor whether the nurse could tactfully comment on the suitability of such a phone call. I'd guess that no-one has that kind of rapport with Dr H.

Sometimes, you just have to act out the motions, like you ring the general registrar on call about a medical problem with a psych patient and they "don't feel comfortable" so you have to call the psych reg just to hear them say "WTF!?" You know that is what they will say but you have to make that call so you can say to the general reg "i asked the psych reg and she said to call you back."

And then the general reg comes to see the pt and has a big fit then tells you it's not your fault. Um...I know. It's yours.

@hannah -- it really does depend on the situation. When dealing with unsafe drs (fortunately, not the norm...), I've gotten good at asking questions until I get what I want. Ex: "Mrs. Jones lives with her elderly husband. Do you feel comfortable with his ability to help her in/out of bed?" or.. "Dr. Grumpy is handling the neuro complaint. Would you want to consult GI for this bleed?"

When I feel a situation is unsafe, I am able to refuse the telephone order (as pointed out). I can take it to the nursing supervisor and work the problem up the food chain. Nurses are supposed to be patient advocates, and I take that role seriously. If a doctor shows frustration, so be it. Though, even that is usually nipped in the bud with a, "don't bite the messenger...this is my job" response.

That kind of laziness is so transparent -- I hate it. And turfing to the nurses because she doesn't know what to do or just doesn't want to make the decision is pretty sad. I'm glad you don't blame the nurses too, because they are just caught in the middle.

Yes, we used to play this game too! But, problem solved. Provider to provider communication--consults must be called in by the ordering provider along with, (get ready for this) a report about the patient, history and why the consult is being ordered. What a concept!! Works better for the services that are often consulted and sure as hell works better for the nurses.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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